Clinical and economic outcomes associated with potentially inappropriate prescribing in the elderly.
ABSTRACT To evaluate the risk of adverse events (AEs) and the healthcare costs for elderly patients receiving specific potentially inappropriate medications (PIMs).
Retrospective cohort study.
Patients 65 years and older who started 1 of 23 PIMs were matched with control subjects who were not receiving PIMs. The following 4 AEs and PIMs were evaluated: delirium or hallucinations with Beers high-severity (BHS) anticholinergics, delirium or hallucinations with BHS narcotics (meperidine hydrochloride or pentazocine lactate or pentazocine hydrochloride), extrapyramidal effects with trimethobenzamide hydrochloride, and falls or fractures with BHS sedative hypnotics. The risk of having the AE of interest within 360 days and the annual healthcare costs were examined.
Patients receiving BHS sedative hypnotics were significantly more likely to have a fall or fracture than controls (hazard ratio, 1.22; 95% confidence interval [CI], 1.10-1.35). Patients receiving BHS anticholinergics did not have higher risk of delirium or hallucinations than controls (hazard ratio, 1.03; 95% CI, 0.91-1.16). Delirium or hallucinations occurred at a higher rate among patients receiving BHS narcotics, and extrapyramidal effects occurred at a higher rate among patients receiving trimethobenzamide; however, too few events occurred to assess statistical significance. For all PIMs evaluated, annual adjusted medical and total healthcare costs were significantly higher for patients exposed to PIMs than for controls.
The use of certain BHS PIMs in the elderly may increase AEs or healthcare costs.
Conference Paper: Linear joint integrated probabilistic data association - LJIPDA[Show abstract] [Hide abstract]
ABSTRACT: Presents an approach for multi-target tracking. In multi-target situations, multiple tracks may share the same measurement(s). Rather than forming joint events by creating all possible combinations of track-measurement assignments, only a single track is processed at a time. Therefore, the number of operations is linear in the number of tracks. The a-priori probabilities of measurement origin are the conduit for inter-track information transfer. The LJIPDA algorithm follows three steps. In the first step, the a-priori probabilities of measurement origin are established for all tracks and all measurements. The next step is measurement oriented and corrects these probabilities. The final step is a modified IPDA algorithm, which uses visibility of measurements to the tracks to calculate the probability of target existence and the data-association probabilities. These probabilities allow track update in the classic PDA fashion, as well as automatic track initiation, maintenance and termination. Simulations are used to verify the performance of the LJIPDA algorithm and compare it with the performance of the IPDA and JIPDA algorithms in a dense and non-homogenous clutter environment, in crossing target situations.Decision and Control, 2002, Proceedings of the 41st IEEE Conference on; 01/2003
Conference Paper: Efficient optimal search of uniform-cost grids and lattices[Show abstract] [Hide abstract]
ABSTRACT: A simple technique is described to speed up optimal path planning on Euclidean-cost grids and lattices. Many robot navigation planning algorithms build approximate grid representations of the environment and use Djikstra's algorithm or A* to search the resulting embedded graph for an optimal path between given start and goal locations. However, the classical implementations of these search algorithms were designed to find optimal paths on arbitrary graphs with edges having arbitrary positive weight values. This paper explains how to exploit the structure of optimal paths on Euclidean-cost grids and lattices in order to reduce the number of neighboring nodes considered during a node expansion step. The result is a moderate reduction in the total nodes examined, which reduces the overall memory requirements and computational cost of the search. These improvements increase the efficiency of optimal robot navigation planning on 2D and 3D grids, and the technique generalizes to any other search problem that involves finding optimal paths on grids and lattices in higher dimensions whose edge costs obey the triangle inequality.Intelligent Robots and Systems, 2004. (IROS 2004). Proceedings. 2004 IEEE/RSJ International Conference on; 01/2004
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ABSTRACT: To provide a comparative overview of explicit criteria that have been developed since 2003 for inappropriate prescribing in older adults and to contrast these newer criteria with the most recent Beers criteria, published in 2003. MEDLINE and Google Scholar searches were performed from 2003 through July 2010. Within MEDLINE, MeSH terms included aged, drug prescriptions, medication errors, and polypharmacy. Free-text search terms included elderly, guideline adherence, inappropriate prescribing, and medications. Related articles, as identified by MEDLINE, were used as well. Free-text search was performed on Google Scholar, using "potentially inappropriate prescribing elderly." Additional articles were identified in reference lists of key articles. Studies were selected if they were published after the most recent revision of the Beers criteria in 2003 and addressed the development and application of explicit criteria for the elderly. We independently reviewed pertinent literature to extract key information. The first explicit criteria published were the Beers criteria, and most research regarding inappropriate medication use applied these criteria. Criteria developed subsequent to the Beers criteria include the French Consensus Panel list, STOPP (Screening Tool of Older Persons' Prescription) and START (Screening Tool to Alert doctors to Right Treatment), the Australian Prescribing Indicators tool, and the Norwegian General Practice Criteria. Newer criteria offer several improvements on the Beers criteria, namely drug-drug interactions, omission of potentially beneficial therapy, and more broadly applicable criteria across international borders. Although no criteria may ever be globally applicable, STOPP and START make significant advances. Regional drug availability, economic considerations, and clinical practice patterns impact criteria selection. Research to validate the several newer criteria in various practice settings and to explore the effect of adhering to the guidelines on patient outcomes is warranted. Data from such research will aid practitioners in identifying preferred criteria.Annals of Pharmacotherapy 11/2010; 44(12):1968-75. DOI:10.1345/aph.1P426 · 2.92 Impact Factor